| Background and objectiveBurning mouth syndrome(BMS)is a chronic burning pain confined to the oral mucosa,usually without obvious clinical signs.At present,the etiology of BMS is not clear.In addition to psychological factors,Neuropathy,especially local fiber neuropathy has become the focus of BMS research.However,there are relatively few studies on the relationship between somatosensory dysfunction and psychological and sleep status in patients with BMS.By evaluating psychological status,sleep status and the quantitative sensory threshold of patients with BMS and exploring their correlation,the purpose of this study is to further explore the pain mechanism of BMS and provide new ideas and basis for the diagnosis,classification and treatment of BMS.Methods1.A total of 120 patients with BMS and 120 healthy controls were collected from the First Affiliated Hospital of Zhengzhou University and the Department of Mucosiology of Henan Stomatological Hospital from October 2018 to January 2021.Visual analogue scales(VAS),pain rating index(PRI)and neuropathic pain scale(DN4)were used to evaluate the degree and nature of pain in patients with BMS.The psychological status of the participants was assessed by Hamilton anxiety scale(HAMA)and Hamilton Depression rating scale(HRSD,24),and the sleep quality of participants was assessed by Pittsburgh Sleep quality Index(PSQI).2.At the same time,the tongue mechanical sensation threshold(MDT)and mechanical pain threshold(MPT)were quantitatively measured in 89 BMS patients with tongue as the main symptom and 89 gender-and age-matched healthy controls.The function of local nerve fibers in the tongue of all participants was evaluated..MDT and MPT were measured at the ulnar surface of the right forearm of all participants as control.One month later,MDT and MPT were measured again in 30 BMS patients whose symptoms improved after treatment.3.The data obtained from this experiment were statistically analyzed by SPSS26.0 software.Independent sample t-test or paired t-test was used to compare the quantitative data with normal distribution,Mann-Whitney U test or paired rank sum test was used for those who did not accord with normal distribution;the χ2 test was used for the comparison between the qualitative data;Spearman or Pearson analysis method was used for the correlation analysis(α=0.05,P<0.05).Results1.The scores of HAMA and HRSD in the BMS group were 14.04± 6.96 and 19.27±8.76 respectively,which were higher than those of healthy control group(3.39±1.84,5.29±1.60).The differences were statistically significant(P<0.05).2.Compared with 20.00%of BMS patients without psychological problems,the incidence of taste disorders in BMS patients with psychological problems was 50.00%higher,and the differences were statistically significant(χ2=10.000,P=0.002*);The score of taste disorder with psychological problems was 7.59±1.59,which was significantly higher than that without psychological problems(5.13 ±1.75).The differences were statistically significant(t=4.714,P<0.05).3.The scores of all dimensions and the total score of PSQI in the BMS group were significantly higher than those in the healthy control group.The differences were statistically significant(P<0.05).4.Compared with the healthy control group 30.00%,the incidence of Sleep disorders(SD)in BMS group was 74.17%,and the differences were statistically significant(P<0.05).In BMS group,the scores of HAMA and HRSD in SD group were 16.57± 5.89 and 22.10± 7.69 respectively,which were significantly higher than those in non-SD group(7.27±4.84,11.55 ±.77),and the difference between the two groups was statistically significant(t1=4.677,P1<0.05;t2=4.011,P2<0.05).5.In BMS group,the scores of HAMA/HRSD were positively correlated with the scores of all dimensions of PSQI and the total scores of PSQI(all P<0.05).6.In BMS group,VAS score,DN4 score and PRI score were positively correlated with HAMA score,HRSD score and total PSQI scores(all P<0.05).7.The MDT of the BMS group of tongue as the main symptom was 1.57± 0.79(g),which was significantly higher than that of healthy control group(1.13±0.35(g)),and the differences were statistically significant(t=2.748,P<0.05),but there was no significant difference in MPT between the two groups(t=1.171,P>0.05).There was no significant difference in MDT and MPT in ulnar skin of right forearm between BMS group and healthy control group(P>0.05);After treatment,the MDT of tongue decreased significantly,and the difference was statistically significant(P<0.05).8.In the BMS group with tongue as the main symptom,the tongue MDT was positively correlated with the course of BMS,while MPT was negatively correlated with the course of disease and the total PSQI scores.However,there was no significant correlation between tongue MDT/MPT and HAMA/HRSD score and pain score(P>0.05).Conclusion1.The occurrence of BMS is closely related to psychological factors,such as anxiety and depression,so it is necessary to give psychological intervention at the same time of drug treatment.2.In patients with BMS,the incidence of sleep disorder is higher,the subjective sleep quality is poor,and the sleep quality is positively correlated with anxiety and depression.While diagnosing and treating BMS patients in clinical work,we must pay close attention to their psychological status and sleep status,and if necessary,multidisciplinary treatment.3.The loss of mechanical sensation in patients with BMS suggests that local neurofibropathy may be one of the pathogenesis of BMS.4.QST has certain application value in diagnosis,classification and evaluation of nerve fiber diseases in BMS. |
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